title: Post-operative spinal epidural hematoma causing American Spinal Injury Association B spinal cord injury in patients with suction wound drains.
abstract: BACKGROUND
  Subfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness.
  
  
  OBJECTIVE
  To report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains.
  
  
  METHODS
  During an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma.
  
  
  RESULTS
  Epidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure.
  
  
  RESULTS
  Three patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3-12 hours). Neurological status significantly improved in all four patients after hematoma evacuation.
  
  
  CONCLUSIONS
  Post-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication.
authors.affiliation: University of Rochester, Rochester, NY 14642, USA. Peter_chimenti@urmc.rochester.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Chimenti
authors.forename: Robert
authors.initials: R
authors.lastname: Molinari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D046748:Hematoma, Epidural, Spinal / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000209:etiology*; D013396:Suction / Q000009:adverse effects* / Q000295:instrumentation